Mary Butler (Waterford, Fianna Fail)
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Budget 2023 saw over €40 million in additional funding for Fair Deal which is providing for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

Overall, nearly €1.5 billion of the total Health Budget for 2023 is allocated to support people under the Nursing Homes Support Scheme (NHSS or Fair Deal).

The Government also continued to provide free PPE and oxygen to private nursing homes, and as of May 2023 this has cost approximately €77 million. A short-term extension to the Temporary Inflation Payment Scheme (TIPS), introduced last year to help with increased energy costs due to inflation, is currently under review.

I recently held a roundtable discussion with private nursing home provider representative groups where the issue of continued support for the sector was on the agenda. I will continue to engage with them going forward.

Discussions on next year’s Estimates and Budget 2024 are ongoing and a wide range of initiatives are under consideration.

It should also be noted that the Department of Health and I have regular interaction with the National Treatment Purchase Fund (NTPF) and have met them to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.

Any nursing home which has had a scheduled renegotiation of their Deed of Agreement with the NTPF this year has seen a significant uplift. These new contracts have seen an average baseline increase in price per bed of between 6% and 7%.

The Government is also cognisant of private and voluntary nursing homes that are not scheduled to renegotiate their Deed of Agreement in 2023.

A significant change that the NTPF have made to their negotiation process is for nursing home providers to agree to a shorter contract duration, which will aim to ensure that NTPF rate increases stay aligned with any cost pressure increases that occur over the course of the contracted period.

The NTPF are the body designated, under Section 40 of the Nursing Homes Support Scheme Act 2009, to negotiate with persons carrying on the business of a nursing home, for the purposes of reaching an agreement on the maximum prices to be charged for nursing home care. There is no role for Ministers in the negotiation process which is conducted and agreed between individual nursing home providers and the NTPF.

There is no other mechanism for funding from the public purse for nursing home residents outside of the NHSS. It is imperative that private and voluntary providers continue to engage in the process as set out in the Nursing Homes Support Scheme Act 2009.

Fair Deal was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families. Government funding for Fair Deal is to support vulnerable older people at a time in their lives where full-time care is essential.

The Nursing Homes Support Scheme covers the cost of the standard components of long-term residential care which are: Nursing and personal care appropriate to the level of care needs of the person; Bed and board; Basic aids and appliances necessary to assist a person with the activities of daily living; and Laundry service.

A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.

The Department of Health is currently reviewing the available evidence and considering various policy options with relation to nursing home charges.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.

Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. Where an individual is not satisfied with the response they receive, they may wish to take their complaint further by seeking a review from the Office of the Ombudsman.

The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes.

The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaint’s procedure of the private nursing home concerned.

The Ombudsman can be contacted as follows:

Office of the Ombudsman

6 Earlsfort Terrace

Dublin 2

D02 W773

Tel. (01) 639 5600 / Lo-call (1890) 22 30 30e-mail at ombudsman@ombudsman.gov.ie

An individual can also use the following website to make a complaint to office of the Ombudsman at the ‘Make A Complaint’ portal on www.ombudsman.ie.

The Competition and Consumer Protection Commission (CCPC) is an independent statutory body with a dual mandate to enforce competition and consumer protection law in Ireland. CCPC’s mission is to promote competition and enhance consumer welfare. The CCPC has published consumer protection guidelines for contracts of care in long-term residential care services for older people. The guidelines set out the obligations and responsibilities that providers must adhere to under consumer protection law and are aimed at providing greater transparency, clarity and certainty for consumers.

A formal complaint can be lodged with the CCPC at the following link: www.ccpc.ie/consumers/how-to-complain/